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Contact Information

CLOVE LAKES ENT PC
1414 VICTORY BLVD
STATEN ISLAND, NY10301
 Phone: 718-447-1261
 Fax: 718-981-1856
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for CLOVE LAKES ENT PC · (Female)

NPI # 1619039815
Status Active
Credentials
Entity Individual
Enumeration date 12/14/2006
Last updated 02/25/2021 - About 5 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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